VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Morningside of Bellgrade
2800 Polo Parkway
Midlothian, VA 23113
(804) 379-2800

Current Inspector: Tamara Watkins (804) 662-7422

Inspection Date: Nov. 10, 2021

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:

A non-mandated complaint inspection was initiated on November 5, 2021 and concluded on November 16, 2021. A complaint was received by the department regarding allegations in the areas of resident care and related services. The Executive Director was contacted by telephone to conduct the investigation. The licensing inspector emailed the Executive Director a list of documentation required to complete the investigation. The licensing inspector conducted an on-site observation at the facility on November 10, 2021. The evidence gathered during the investigation supported the allegation of non-compliance with standards or law, and violations were issued. Any violations not related to the complaint but identified during the course of the investigation can be found on the violation notice.

Violations:

Standard #:	22VAC40-73-450-C
Complaint related:	No
Description:	Based on record review and interview with staff, the facility failed to ensure the comprehensive individualized service plan (ISP) included a description of identified needs based on the UAI. Evidence: 1. Resident #1?s Uniform Assessment Instrument (UAI) dated 8-17-2021 documented the resident requires mechanical help with the use of a walker for walking; however, Resident #1?s ISP dated 8-19-2021 documented resident ambulates independently and does not specify use of the walker. 2. Resident #1?s UAI documented the resident requires assistance with meal preparation, housekeeping, laundry, and money management; however, none of those services were identified on the ISP. 3. Resident #1?s UAI documented the resident is appropriate and oriented; however, the ISP documented Resident #1 is disoriented some spheres, some of the time. 4. Staff #1 confirmed the information on the UAI was correct and that the aforementioned required information was not identified on the ISP as it was on the UAI.
Plan of Correction:	DON and ADON will ensure that UAIs and ISP's match and are correct for the care needs of the residents. They will conduct quarterly reviews of both to ensure that the documentation is correct with the level of care provided to the residents.
Standard #:	22VAC40-73-650-B
Complaint related:	Yes
Description:	Based on record review and interview with staff, the facility failed to ensure physician or other prescriber orders, identified the diagnosis, condition, or specific indications for administering each drug. Evidence: 1. Resident #1?s physician?s order sheet signed on 10-20-2021 did not identify the diagnosis, condition, or specific indications for administering the following drugs: Basaglar Kwikpen and Sanctura 20 mg. 2. Resident #1?s physician?s order sheet signed on 8-18-2021 did not identify the diagnosis, condition, or specific indications for administering the following drugs: Furosemide, Soy Isoflavone, Apidra, and Lexapro. 3. Staff #1 confirmed the aforementioned diagnosis, condition, or specific indications were not provided for Resident #1?s medications.
Plan of Correction:	It is the policy of Morningside at Bellgrade to follow all the VA state guidelines and regulations for Assisted Living communities. This violation has been corrected since the time of the inspection. DON will designate a staff member to perform weekly audits of the MAR's to ensure that all diagnosis are present for all ordered medications. This will also include a audit to ensure that we have no "holes" in our documentation on the MAR's.
Standard #:	22VAC40-73-680-D
Complaint related:	Yes
Description:	Based on the review of resident records, the facility failed to administer medications in accordance with the physician's or other prescriber's instructions and consistent with standards of practice outlined in the current registered medication aide curriculum approved by the Virginia Board of Nursing. Evidence: 1. Commonwealth of Virginia Board of Nursing Medication aide Curriculum for Registered Medication Aides, Revised May 21, 2013 states: a. Chapter 5, Section 5.1 titled, "5.1 Describe Three Types of Forms Commonly Used to Document Medication Administration" states, "Documentation is an important part of medication management. It is frequently referred to as the "6th Right" of medication administration". b. Section 5.3. titled "Document Medication Administration on the Medication Administration Record [MAR] states, "All medications administered or omitted" under "What to Document". 2. Resident #1?s August 2021 MAR had no documentation of medication administration or omission was completed on the resident?s blood sugars at the following dates and times: a. 8-16-2021 at 8:00 a.m.; b. 8-04-2021, 08-06-2021, 8-11-2021, 8-14-2021, 8-15-2021 at 12:00 p.m.; and c. 8-05-2021, 8-12-2021, and 8-16-2021 at 8:00 p.m. 3. Additionally, Resident #1?s August 2021 MAR had circled initials (circled initials on the MAR code to indicate resident refused the medication, reason required to be documented) documented on the MAR for the following medications not administered to Resident #1: a. Amlodipine Besylate 5 mg, Vitamin C, Soy Isoflavone, and Metoprolol Succinate 100 mg on 8-17-2021 through 8-19-2021; and b. Bupropion XL 150 mg, Farxiga F/C 10 mg, Furosemide 20 mg, and Januvia 50 mg on 8-19-2021. 4. Staff #1 confirmed, ?the back of all the MAR's are blank? regarding the aforementioned dates and times medications were not administered or omitted.
Plan of Correction:	All medication aides and nurses will complete a refresher course for medication management in January 2022. This course will include the 5 rights as well as proper medication documentation.
Standard #:	22VAC40-73-680-I
Complaint related:	Yes
Description:	Based on record review and interview with staff, the facility failed to ensure the medication administration record (MAR) included the diagnosis, condition, or specific indications for administering the drug. Evidence: 1. Resident #1?s July 2021 MAR did not document the diagnosis, condition, or specific indications for administering the following: Vitamin B-12, Bupropion XL 150 mg, Cyanocobalamin B-12 1000mcg, Losartan Potassium F/C 50 mg, Nystatin cream, 2. Resident #1?s August 2021 MAR did not document the diagnosis, condition, or specific indications for administering the following: Bupropion XL 150 mg, Escitalopram Oxalate F/C 10 mg, Farxiga F/C 10 mg, Furosemide 20 mg, Losartan Potassium F/C 50 mg, Tradjenta 5 mg, Soy Isoflavone, Vitamin B-12, Vitamin C, and Januvia 50 mg. 3. Resident #1?s August 2021 MAR documented the diagnosis for Metoprolol Succ 100 mg as ?for diabetes mellitus?; however, Staff #1 confirmed the medication was for resident?s hypertension. 4. Staff #1 confirmed the aforementioned diagnosis, condition, or specific indication for administering Resident #1?s drugs were not on the August 2021 MAR.
Plan of Correction:	DON will designate a staff member to perform weekly audits of the MAR's to ensure that all diagnosis are present for all ordered medications. This will also include an audit to ensure that we have no "holes" in our documentation on the MAR's.